Clinical Resources for Intrathecal Analgesia

Evidence-based guidelines derived from SFETD Toolbox 2024 and PACC international recommendations

Educational Resources

These comprehensive guides synthesize clinical information from the SFETD (Société Française d’Étude et de Traitement de la Douleur) Intrathecal Analgesia Toolbox 2024 and international expert consensus guidelines.

Clinical Practice Guidelines

Intrathecal Analgesia Indications

Comprehensive guide to patient selection and clinical indications for intrathecal drug delivery systems:

Patient selection criteria for cancer and non-cancer pain
Absolute and relative contraindications based on SFETD guidelines
Collegial decision-making process and multidisciplinary team composition
Anatomical considerations for catheter positioning
Evidence base from French (SFETD, SFAR, HAS) and international sources

Target Audience: Pain management specialists, oncologists, palliative care physicians, anesthesiologists

Intrathecal Drug Protocols

Evidence-based medication protocols for intrathecal analgesia:

PACC international recommendations (first, second, third-line therapies)
Morphine dosing references from the literature, with conversion formulas (oral to IT)
Local anesthetics (ropivacaine, bupivacaine) for neuropathic pain
Ziconotide protocols for refractory pain with gradual titration strategies
Drug combinations and compatibility based on pH and stability data
Flow rate settings and bolus programming
Titration strategies from the literature for insufficient analgesia or adverse effects

Target Audience: Prescribing physicians, clinical pharmacists, pain management nurses

Reference Materials

Medical Terminology Glossary

Comprehensive glossary of intrathecal analgesia terminology:

Over 80 medical terms defined from SFETD standards
Acronym quick reference for clinical documentation
Drug classifications and mechanisms of action
Pump technology terminology (IDDS, SynchroMed II, myPTM)
Procedural terms (refill, programming, bolus types)
Regulatory terminology (HDS, FHIR, CE marking)

Target Audience: Multidisciplinary teams, medical students, healthcare administrators

Evidence Base

These educational resources are synthesized from authoritative sources:

French Guidelines

SFETD Intrathecal Analgesia Toolbox (2024)

Comprehensive practical handbook developed by expert panel
Endorsed by SFETD Pain and Cancer Commission
Covers complete patient pathway from pre-implantation to end-of-life care

HAS Recommendations (2020)

Official recognition of intrathecal analgesia for refractory cancer pain
Published by Haute Autorité de Santé (French national health authority)

SFETD/SFAR Formalized Expert Recommendations (2013)

Joint recommendations from French pain and anesthesia societies
Established clinical standards for intrathecal therapy in France

DGOS Instruction (2017)

Direction Générale de l’Offre de Soins official guidance
Regulatory framework for intrathecal analgesia programs

International Guidelines

Polyanalgesic Consensus Conference (PACC) 2017

International expert consensus on intrathecal drug delivery
Evidence-based medication selection and dosing algorithms
Risk mitigation strategies for safe implementation

Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks. Neuromodulation. 2017 Feb;20(2):155-176.

Clinical Context

The Challenge

Approximately 15% of cancer patients experience refractory or intractable pain, particularly in advanced disease stages. According to the SFETD:

“Intrathecal analgesia should be made available in all of France to ensure equal access to care. This objective is still far from being achieved.”

Unfortunately, healthcare professionals are insufficiently informed about intrathecal analgesia potential, and the technique is underutilized despite its demonstrated effectiveness.

The Solution

The SFETD Intrathecal Toolbox provides:

Practical information for pain teams wishing to develop intrathecal analgesia programs
Day-to-day practice guidance for implant facilities, initiation centers, and follow-up departments
Structured workflows adapted to local resources
Patient pathway organization from pre-implantation through long-term management

Implementation Support

Thalivia digitalises the traceability of data associated with these protocols:

Structured data entry aligned with SFETD good-practice guidance
Structured display from the entered data
Tracking of drug stability durations (21-day morphine-ropivacaine-ziconotide protocol)
Pharmacy integration for ISO 5 cleanroom preparation workflows
Complete traceability meeting HDS and GDPR requirements

Learn more about Thalivia’s clinical features →

For Healthcare Institutions

Developing Intrathecal Programs

The SFETD Toolbox identifies prior requirements for starting intrathecal therapy:

Team Requirements:

Motivated physicians trained or amenable to training (minimum 2)
Dedicated nurses familiar with technique (minimum 2)
Implanting anesthetist or neurosurgeon
Coordination (nurse and secretary)

Infrastructure:

Technical platform for implantation
Full hospitalization beds for post-operative equilibration
Day hospital for pump filling and programming
Mandatory partnership with in-house pharmacy

Pharmacy Capabilities:

ISO 5 cleanroom (laminar flow hood)
Dedicated staff with availability
Drug preparation or dispensing capacity
Stability expertise for intrathecal mixtures

Administrative Framework:

Service project validated by relevant authorities
Collaboration agreements across entities
24/7 telephone hotline
IT tool to secure intrathecal data entry

Contact Thalivia for institutional implementation support →

Continuing Education

Target Audiences

These resources serve healthcare professionals involved in intrathecal analgesia:

Pain Management Specialists (algologists)
Anesthesiologists performing implantations
Oncologists managing cancer pain
Palliative Care Physicians treating end-stage disease
Clinical Pharmacists preparing intrathecal mixtures
Pain Management Nurses performing refills and patient education
Hospital Administrators developing pain management programs

Learning Objectives

After reviewing these resources, clinicians will understand:

Patient Selection: Indications, contraindications, and collegial decision-making processes
Medication Protocols: PACC-aligned drug selection, dosing references from the literature, and titration strategies
Safety Protocols: Complication prevention, adverse effect management, and error reduction
Technical Procedures: Pump implantation, refilling techniques, and programming workflows
Organizational Requirements: Team structure, pharmacy integration, and regulatory compliance

Evidence-Based Practice

Thalivia supports the traceability of data associated with these guidelines through:

Display and Data Structuring:

Structured conversion display from physician entries (oral/IV to intrathecal)
Display of local anaesthetic dosing entered by catheter level (cervical vs. thoracic)
Display of ziconotide dose history entered by the user

Safety Features (data entry):

Range alerts on data entry (e.g., morphine above 5 mg/24h at initiation)
Structured checks on flow rate (typical start: 1 mL/day IDDS)
Structured checks on bolus parameters (refractory period, max activations)
Drug stability duration tracking (21-day MRZ mixture limit)

Workflow Integration:

Pharmacy collaboration per SFETD circuit recommendations
Collegial decision documentation
Complete audit trail for regulatory compliance
FHIR/HL7 interoperability with EMR systems

Any clinical interpretation or therapeutic decision remains the sole responsibility of the physician.

Book a demo to see SFETD protocols in action →

Intrathecal Analgesia Protocols - Morphine Calculations, Pumps, HAS Compliance